Outcomes of a COVID-19 respiratory follow up clinic in a large tertiary referral centre

Introduction Current guidelines for follow up of COVID-19 patients are based on experience with outbreaks with Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), with the aim to identify patients likely to develop post infectious fibrosis The COVID-19 pandemic is on a much larger scale and requires investigation regarding the most effective way to follow up these patients Methods We set up a pathway to allow us to screen selected discharged patients to identify those who required further investigations Discharged patients were identified following admission between March and June 2020 using electronic hospital records Patients who were not suitable to be called were excluded, and a letter was written to their GP explaining this All other patients were called approximately 6 weeks after discharge Information was collected including ongoing symptoms, admission radiological changes, and selected questionnaires Patients with ongoing symptoms were invited back for investigations and face-to-face appointment, and anyone without symptoms but x-ray changes was invited for repeat X-ray at 10 weeks Results Of the 828 admissions, 281 died, and a further 182 were unsuitable to call Of those called, 88% (321) answered, and 65 remained symptomatic and were seen in clinic 154 people required a repeat chest x-ray, 8 subsequently had a CT thorax and clinic review 56 people did not attend for follow-up x-ray and were discharged Of the 73 people seen, 59 had interstitial changes based on radiological criteria;29 of these were resolving inflammation which did not require further follow up as the patients were also clinically improving 30 patients, 11 with fibrotic changes, required observation or treatment Four patients received oral prednisolone and 7 had received intravenous methylprednisolone earlier In the symptomatic group, PEs, pulmonary hypertension, adenocarcinoma in situ and breathing pattern disorders were also diagnosed Conclusion Less than 10% of patients required treatment with steroids after admission with COVID-19 infection This is lower than previous estimates following MERS/SARS infection Interestingly, severe radiology changes did not predict the likelihood of developing fibrosis The screening telephone clinic was a useful way of identifying those with ongoing symptoms who required further investigation